How does Sarva stay current with payer policy changes?

Sarva continuously monitors payer policy bulletins, provider manuals, and portal updates. When a payer changes a rule, the library is updated and staff are notified if the change impacts existing workflows. Most updates are applied within days of publication.

What happens if we work with a payer not in the library?

Sarva routes encounters for that payer to manual handling while building the payer profile through analysis of the payer's public policies and portal requirements. Most new payers are fully integrated within 1–2 weeks.

Use Case

Payer Workflow Automation Across All Your Payer Relationships

Payer workflow automation applies AI to manage the unique rules, requirements, and communication channels of each payer your practice works with. Sarva maintains a continuously updated library of payer-specific policies covering eligibility, prior authorization, claim submission, status checking, and appeal procedures — so your team follows the right process for every payer without memorizing each one.

Automate Your Payer Workflows

The Business Problem

Every payer has different rules: different prior authorization requirements, different claim formatting preferences, different appeal submission processes, different portal interfaces. Staff must maintain knowledge of dozens of payer-specific workflows, which is impossible at scale. The result is inconsistent processes, payer-specific errors, and denials caused by not following a payer's unique requirements.

Affected Team

Billing, front desk, prior authorization, and denials staff. Every team that interacts with payers is affected by the complexity of payer-specific rules.

How It Works

Current Manual Workflow

Staff maintain binders, spreadsheets, or shared documents with payer-specific requirements. When a new payer is added or a payer changes a policy, someone must manually update the documentation and communicate the change to all staff. In practice, documentation is often outdated and staff rely on institutional knowledge that varies by individual.

Automated Workflow with Sarva

Sarva maintains a payer-specific rules library that is continuously updated as policies change. When a claim, authorization, or appeal is processed, Sarva automatically applies the correct rules for the destination payer. Staff do not need to know each payer's unique requirements — Sarva handles payer-specific formatting, submission channels, and follow-up procedures automatically.

Inputs

Payer-specific policy library (continuously updated)
Claim and authorization data
Payer portal credentials and EDI connections
Historical payer interaction data

Outputs

Payer-specific claim formatting and submission
Payer-specific authorization procedures
Payer-specific appeal formatting and channels
Payer performance benchmarking
Policy change alerts when payers update rules

Human Oversight

Staff are notified when Sarva detects a payer policy change that may impact workflows. For new payers not yet in the library, Sarva routes encounters for manual handling while building the payer profile. Staff handle exceptions and payer-specific escalations.

Security Considerations

Payer credentials are encrypted and stored securely. All payer interactions are logged with full audit trails. No data shared between customers. HIPAA BAA included. SOC 2 Type II certified.

Integration Considerations

Sarva connects to payer portals, EDI gateways, and clearinghouse connections. The payer rules library is pre-populated with all major commercial payers, Medicare, and Medicaid managed care plans. New payers are added through onboarding analysis of their public policies and portal requirements.

Limitations

The payer library covers all major payers but may not include very small regional or specialty payers. New payers require an onboarding period (1–2 weeks) to build the profile. Payer policy changes are tracked promptly but there may be a brief lag between a payer updating a policy and the library being updated.

Key Performance Indicators

Payer-specific rule compliance

Target

> 98%

Payer policy change detection

Target

< 7 days lag

Payer-specific denial reduction

Target

50% per payer

New payer onboarding time

Target

< 2 weeks

See how this workflow applies to your practice.

Automate Your Payer Workflows

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Frequently Asked Questions

Sarva maintains payer-specific rules for all major commercial payers (Blue Cross Blue Shield, UnitedHealthcare, Aetna, Cigna, Humana, etc.), Medicare and Medicare Advantage plans, and Medicaid managed care plans in all 50 states. Smaller regional payers can be added through onboarding.

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